Provider Demographics
NPI:1275784217
Name:BRACKETT RHEUMATOLOGY PLLC
Entity Type:Organization
Organization Name:BRACKETT RHEUMATOLOGY PLLC
Other - Org Name:PHYSICIANS RX OF CHATTANOOGA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BRACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-893-6890
Mailing Address - Street 1:1 BURTON HILLS BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6293
Mailing Address - Country:US
Mailing Address - Phone:615-884-0302
Mailing Address - Fax:615-884-0305
Practice Address - Street 1:6145 SHALLOWFORD RD
Practice Address - Street 2:STE 102
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7808
Practice Address - Country:US
Practice Address - Phone:615-884-0302
Practice Address - Fax:615-884-0305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000045523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2117357OtherPK